Segmental zoster paresis of unilateral upper extremity

Abstract

Rationale: Segmental zoster paresis (SZP) is a relatively rare neurologic complication of herpes zoster (HZ), and is characterized by focal asymmetric motor weakness in the myotome that corresponds to skin lesions of the dermatome. The upper extremities are the second most commonly involved regions after the face, and predominantly involve proximal muscles. The pathogenesis of SZP remains unclear; however, most of the reports indicate that it is the inflammation because of the spread of the herpes virus. Patient concerns: A 72-year-old man without trauma history of the left shoulder joint developed weakness of the left proximal upper extremity 10 days after vesicular eruption of HZ. Diagnoses: His left shoulder girdle paresis was diagnosed with the upper truncus of the brachial plexus as a HZ complication according to a series of tests, including cervical magnetic resonance imaging (MRI), cerebral fluid analysis, sonography, and electrophysiological studies. Interventions: Acyclovir and prednisolone were administered during hospitalization to treat SZP. Meanwhile, analgesics and gabapentin were administered to control the patient's neuralgic pain. He also received inpatient (daily) and outpatient (3 times per week) physical therapy along with range of motion and strengthening exercises. Outcomes: Partial improvement of the strength of the left shoulder girdle, and no improvement of the left deltoid muscle was observed 2 months after the interventions. Lessons: This case emphasizes that HZ infections may be complicated by segmental paresis and they should be considered in the differential diagnosis of acute paresis in the upper limb. Awareness of this disorder is important because it avoids unnecessary invasive investigations and interventions, leading to suitable treatments with favorable prognosis.

Analysis of Risk Factors and Construction of a Prediction Model of Motor Dysfunction Caused by Limb Herpes Zoster

“…[9][10][11][12][13] When varicella-zoster virus invades the anterior nerve root, patients experience decreased muscle strength and motor dysfunction, which usually occurs within a few weeks after the appearance of the rash. 14 Since Broadbent first reported a case of motor dysfunction caused by cervical herpes zoster in 1866, a number of cases have been reported, [15][16][17][18] including literature reporting that the incidence of motor dysfunction in patients with herpes zoster was only 0.3%-5.0%, but Mondelli et al found that more than half of the patients with herpes zoster had limb motor nerve involvement, indicating that a large number of patients were missed. 19 In our study, when MRC score rather than electromyography was used, the overall incidence of motor dysfunction reached 4.59% (58/1264), which may be underestimated.…”

Complete recovery of herpes zoster radiculopathy based on electrodiagnostic study: A case report

“…The severity of radiculopathy could be estimated through CMAP amplitude or the amount of ASA in the involved muscles. Several previous studies diagnosed segmental zoster radiculopathy via electrodiagnostic study[ 13 , 14 ]. Chen et al [ 13 ] reported a case of segmental zoster paresis with electrodiagnostic findings of decreased amplitude in several nerves and ASA in clinically involved muscles[ 13 ].…”

“…Several previous studies diagnosed segmental zoster radiculopathy via electrodiagnostic study[ 13 , 14 ]. Chen et al [ 13 ] reported a case of segmental zoster paresis with electrodiagnostic findings of decreased amplitude in several nerves and ASA in clinically involved muscles[ 13 ]. According to Liu et al [ 14 ], electrodiagnostic study of 8 segmental zoster paresis patients revealed low amplitude of CMAPs or sensory nerve action potentials with various ASA in all patients[ 14 ].…”

A Rare Complication of Herpes Zoster: Segmental Zoster Paresis

“…HZ can lead to numerous complications, including postherpetic neuralgia, encephalitis, aseptic meningitis, and segmental zoster paresis (SZP). SZP is a rare complication of HZ that results in focal weakness of the extremity in the myotome that corresponds to dermatomal involvement [3][4][5]. SZP affects approximately 0.5% to 5% of patients with HZ [3,4].…”

“…SZP is a rare complication of HZ that results in focal weakness of the extremity in the myotome that corresponds to dermatomal involvement [3][4][5]. SZP affects approximately 0.5% to 5% of patients with HZ [3,4].…”